CUA 2017: The Prevalence and Biopsychosocial Predictors of Suicidality in Men with Prostate Cancer

Toronto, Ontario ( Dr. Dean Tripp and colleagues presented their study assessing prevalence and biopsychosocial predictors of suicidality in men with prostate cancer at the poster session on GU oncology at the CUA 2017 annual meeting. Prostate cancer is associated with higher depression levels than the general population, with upwards of 20% of men having clinical depression1.

Furthermore, previous studies have noted higher levels of suicide in men with prostate cancer compared to the general population2, specifically many years after diagnosis, and to other solid organ malignancies3, within the first year of diagnosis. Indeed, prostate cancer and suicidality are two of the primary initiatives of the well-known Movember campaign 4,5. The objectives of this study were to establish a point prevalence for suicidality among patients diagnosed with prostate cancer and to evaluate what biopsychosocial variables predict risk of suicidality in these men.

For this study, men with prostate cancer were recruited from a single institution (Queen’s University, Kingston, ON, Canada) and prostate cancer support group (Prostate Cancer Canada) to complete an online survey (n=243 completed the survey, 53% overall response rate). The survey consisted of the functional, emotional and social well-being subscales of the FACT-P questionnaire, the perceived interpersonal burdensomeness and thwarted belongingness scales (INQ-10), and suicide behavior questionnaire revised (SBQ-R). Specific suicidality questions included (i) “Have you ever thought about or attempted to kill yourself?” (ii) “How often have you thought of killing yourself in the last year?” (iii) “Have you ever told someone that you were going to commit suicide or that you might do it?” (iv) “How likely is it that you will attempt suicide someday?” Subsequently, hierarchical regression models were used to predict suicidality using biopsychosocial variables. 

Among survey respondents, 76.8% of men were diagnosed with localized prostate cancer and 23.2% with advanced disease. The treatments received were prostatectomy (63.4%), radiotherapy (42.4%), and androgen-deprivation therapy (36.6%), chemotherapy (5.8%), and other therapy (16.9%, ie. brachytherapy). With regards to suicidality, 16.9% of men were classified as ‘at-risk’ using a general population cut-score (SBQ-R ≥7) and 10.3% using the inpatient population cut-score (SBQ-R ≥8). On hierarchical regression, shorter length of diagnosis (ß = -0.16), lower functional well-being (ß = -0.21), higher exposure to suicide (ß = 0.26), greater hopelessness (ß = 0.32), and greater perceived burdensomeness (ß = 0.23) were significantly associated with higher suicidality scores. Interestingly, cancer stage was not a significant predictor of suicidality. 

The strength of the study is the unique study design prospectively assessing risk of suicide, and the collaboration between psychologists and urologists. The findings require external validation; however, this study is part of a larger international collaborative effort. 

In summary, the authors concluded that exposure to suicide and reduced emotional well-being were associated with greater suicidality. Additionally, thwarted belongingness, or the extent to which individuals believe their need to belong is met/unmet, appear to be modifiable risk factors for these ‘at-risk’ patients. Screening and identifying these patients for early psychologic/psychiatric assessment may be beneficial in reducing risk of suicide.

Presented By: Dean A. Tripp, Queen’s University, Kingston, ON, Canada

Co-Authors: Phylicia Verreault, Jason P. Izard, Angela Black, D. Robert Siemens

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre  Twitter: @zklaassen_md at the  72nd Canadian Urological Association Annual Meeting - June 24 - 27, 2017 - Toronto, Ontario, Canada

1. Ravi P, Karakiewicz PI, Roghmann F, et al. Mental health outcomes in elderly men with prostate cancer. Urol Oncol 2014;32(8):1333-1340.

2. Klaassen Z, Jen RP, DiBianco JM, et al. Factors associated with suicide in patients with genitourinary malignancies. Cancer 2015 Jun 1;121(11):1864-1872.

3. Dalela D, Krishna N, Okwara J, et al. Suicide and accidental deaths among patients with non-metastatic prostate cancer. BJU Int 2016 Aug;118(2):286-297.

4. Movember Canada.

5. Movember USA.